Impact of Timing of Surgery and Adjuvant Treatment on Survival of Adult IDH-wild-type Glioblastoma: A Single-center Study of 392 Patients

Tuomas Natukka; Joonas Haapasalo; Tomi Kivioja; Linnea Rajala; Jani Raitanen; Jaakko Nevalainen; Sirpa-Liisa Lahtela; Kristiina Nordfors; Minna Rauhala; Arja Jukkola; Juhana Frösen; Pauli Helén; Anssi Auvinen; Hannu Haapasalo

doi:10.1016/j.wneu.2023.07.008

Impact of Timing of Surgery and Adjuvant Treatment on Survival of Adult IDH-wild-type Glioblastoma: A Single-center Study of 392 Patients

World Neurosurg. 2023 Jul 7:S1878-8750(23)00933-6. doi: 10.1016/j.wneu.2023.07.008. Online ahead of print.

Authors

Affiliations

¹ Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland. Electronic address: tuomas.natukka@tuni.fi.
² Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland; Department of Neurosurgery, Tampere University Hospital, Tampere, Finland; Department of Pathology, Fimlab Laboratories Ltd, Tampere, Finland; Tays Cancer Center, Tampere University Hospital, Tampere, Finland.
³ Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland.
⁴ Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland; Department of Neurosurgery, Tampere University Hospital, Tampere, Finland.
⁵ Tampere University, Faculty of Social Sciences, Tampere, Finland; UKK Institute for Health Promotion Research, Tampere, Finland.
⁶ Tampere University, Faculty of Social Sciences, Tampere, Finland.
⁷ Department of Oncology, Tampere University Hospital, Tampere, Finland.
⁸ Tays Cancer Center, Tampere University Hospital, Tampere, Finland; Tampere Center for Child Health Research, Tampere University, Tampere, Finland.
⁹ Department of Neurosurgery, Tampere University Hospital, Tampere, Finland.
¹⁰ Tays Cancer Center, Tampere University Hospital, Tampere, Finland; Department of Oncology, Tampere University Hospital, Tampere, Finland.
¹¹ Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland; Department of Pathology, Fimlab Laboratories Ltd, Tampere, Finland.

PMID: 37423335
DOI: 10.1016/j.wneu.2023.07.008

Abstract

Background: The purpose of our study was to analyze the impact of time interval from referral to surgery and from surgery to adjuvant treatment on survival of adult isocitrate dehydrogenase-wild-type (IDH-wt) glioblastomas.

Methods: Data on 392 IDH-wt glioblastomas diagnosed at the Tampere University Hospital in 2004-2016 were obtained from the electronic patient record system. Piecewise Cox regression was used to calculate hazard ratios for different time intervals between referral and surgery, as well as between surgery and adjuvant treatments.

Results: The median survival time from primary surgery was 9.5 months (interquartile range: 3.8-16.0). Survival among patients with an interval exceeding 4 weeks from referral to surgery was no worse compared to <2 weeks (hazard ratio: 0.78, 95% confidence interval: 0.54-1.14). We found indications of poorer outcome when the interval from surgery to radiotherapy exceeded 30 days (hazard ratio: 1.42, 95% confidence interval: 0.91-2.21 for 31-44 days; and 1.59, 0.94-2.67 for over 45 days).

Conclusions: Interval from referral to surgery in the range of 4-10 weeks was not associated with decreased survivals in IDH-wt glioblastomas. In contrast, delay exceeding 30 days from surgery to adjuvant treatment may decrease long-term survival.

Keywords: Brain neoplasms; Glioblastoma; Isocitrate dehydrogenase; Survival; Time-to-Treatment.